Over the past decade, much effort has been directed toward the development and empirical testing of comprehensive psychotherapy interventions designed to target suicidal and non-suicidal self-injurious behaviors. Less effort has been devoted to incorporating these treatments into clinical training programs, or to training clinicians to conduct psychotherapy research. Dialectical Behavior Therapy (DBT) was identified in the RFA as a """"""""scientifically validated behavioral treatment"""""""" for self-harm behaviors. The treatment is primarily taught in doctoral programs that train clinical psychologists. Yet, psychiatrists are often on the front lines of treating suicidal patients. We propose to develop, implement, evaluate and disseminate a comprehensive psychotherapy and research training curriculum for psychiatry residents using Dialectical Behavior Therapy for self- harm behaviors. We propose a 12-month DBT clinical/research training for psychiatry residents at Columbia University that combines didactic seminars, videotape rating and training, and case supervision. The curriculum has two integrated components. One is a comprehensive clinical training program for residents to learn the principles, concepts and interventions of conducting DBT for self-harm behaviors. A concurrent research curriculum will teach basic principles of conducting psychotherapy research, specifically to conduct research testing the efficacy of DBT in the reduction of self-harm behaviors. The faculty will consist of senior DBT trainers and researchers. The clinical component will include a 5 -day clinical DBT intensive along with weekly group consultation team supervision sessions and 15 hours of clinical training through peer videotape coding and rating. The research component will consist of 25 one- hour didactic sessions related to the conduct of psychotherapy efficacy trials and suicide intervention research on topics of study design, procedures for psychotherapy trials, the role of the psychiatrist in psychotherapy research, data analysis, manualization and adherence.
The specific aims of this application are to: 1) develop a core curriculum for training psychiatry residents in DBT clinical interventions and research methods with suicidal and self-harming clinical populations;2) develop a criterion-based evaluation of basic skill in DBT;3) disseminate this training and the evaluation to other psychiatry residency training programs in the country. The proposed evaluation component includes the development and validity testing of a new measure designed to assess the achievement of clinical skill in DBT. This measure will be compared with reliable DBT adherence ratings. Basic knowledge of DBT principles, interventions and research methodology will be assessed by a final examination. The dissemination of this curriculum and evaluation plan will take place through workshops at residency training administrative conferences, publications, website postings, and consultation to residency training programs throughout the country.

Public Health Relevance

Suicide and self-harm behaviors have been identified by the Surgeon General to be high priority public health concerns. The proposed research plan is to teach psychiatry residents to conduct Dialectical Behavior Therapy (a psychotherapy empirically shown to reduce self-harm behaviors), and to conduct psychotherapy research to further test the efficacy of DBT in reducing self-harm behaviors. The proposed curriculum will serve as a model to incorporate such trainings into residency programs throughout the country to effectively reduce and prevent suicide and self-harm behaviors.